The nation’s fourth largest health insurer is refusing a request from radiologists to pause its prior-authorization policy until after the COVID crisis clears.
Cigna recently revealed its decision in a letter sent to American College of Radiology leadership. Senior Medical Director John Keats, MD, noted that 85% of the payer’s clients are self-funded, and they “expect us to ensure that the care provided to their employees and dependents is safe, effective and medically necessary,” he wrote.
Keats’ comments come in response to an April letter, sent by the college to the heads of major commercial insurers. In it, ACR expressed concerns about how these policies may impact the specialty when working through its “enormous” backlog of imaging studies.
“Cigna is committed to working with providers to improve the quality of patient care and safety. Our prior-authorization programs play a significant role in these efforts,” Keats wrote May 6. “By ensuring that patients receive the most appropriate imaging procedures to meet their needs, the quality of their care is enhanced.”
While the Connecticut-based company is not pausing prior authorization, Keats did share several steps it is taking to cut red tape. Cigna is processing about 98% of such requests within two days of submission, and making its experts available seven days a week, including evenings. Plus, about 70% of prior-authorization requests are being submitted through its web portal, which typically takes 5 minutes or less.
“In addition, we continue to monitor the COVID-19 outbreak very closely and recently made some programmatic changes to address this evolving situation,” Keats added, noting that Cigna has expanded the “minimum duration” of all prior authorizations from 90 days up to 180. This means that similar past Cigna approvals in the last six months will be applied to new similar prior authorization requests. “This will ensure that requests approved prior to and during the pandemic can be fulfilled as soon as is safe and feasible for patients,” Keats added.
In a news post, ACR said it has not yet received a response from Anthem, Aetna, Health Care Services Corporation and UnitedHealthcare as of May 7. You can read the entire response from Cigna here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.